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Abstract
Background and Aims Morbid obesity is associated with a significantly higher risk of pre-existing medical conditions, developing antenatal complications, induction of labour, caesarean section. We report the anesthetic management of a multigravida woman with morbid obesity.
Methods A 36 years old, multigravida with 41 weeks’ gestation, 198 kg, BMI 67, with massive swelling of lower limbs and body presented for the procedure of delivery. There was no history of any significant co- morbidity. The surgical history included aprendectomy, tonsillectomy and inguinal hernia repair. She was a medium smoker and she was 110 kg in her first gestation. The baseline vital parameters including heart rate (HR), non-invasive blood pressure (NIBP), electrocardiogram (ECG) and oxygen saturation (SpO2) were attached and noted. The patient was planned to give epidural anesthesia for vaginal delivery in sitting position. An informed consent was obtained from the patient for publication of the report without disclosing his/her identity. The lumbar puncture was done at L2-L3 interspace. The epidural space was found in 7 cm and the catheter was inserted plus 7 cm.
Results The baseline parameters recorded were, HR68/min, NIBP-110/50, and SpO2–97%.
After 3 doses of epidural LEVOBUPIVAINE 0,2% 10 ML+ fentanyl 15γ and 4 hours later a live 3.5 kg baby was delivered. The procedure remained uneventful.
Conclusions We concluded that the proper preanesthetic evaluation including history, relevant investigations, proper patient positioning both before and after giving neuraxial anesthesia with proper explanation to the patient about the procedure played a key role in successful management of such case by an anesthesiologist.